Last year as most know BCBS of Florida outsourced the provider relations of the behavioral health to New Directions. This transition has been wrought with issues.
One of the issues is providers that were in network with BCBS of Florida prior to New Directions were asked to re enroll. List of providers were given to New Directions but some of the providers got missed. Although they had a grace period between 12/01/2011 and 02/29/2012 still some got left out. If you are working with a big practice, that is not hard to miss. Recent conversations on this subject indicate that even though they were provided the initial list back in September and missed sending the necessary paperwork to the providers they will not make their enrollment retroactive. So a provider that was seeing clients after 02/29/2012 and was previously in network and they failed to properly process the paperwork is out of network after that date. They will enroll these providers again but with a date of their choosing.
Second issue is related to those in network providers who file claims under a Group Name and Tax Identification. Those providers are being treated as out of network and paid according to out of network benefits. We have been working very closely with New Directions to correct this issue. If either of these issues is being experienced by your practice, please don’t hesitate to contact us for additional information. We are compiling data and will share this information with New Directions. We believe this to be a widespread issue and the challenge will be to get it corrected.
11/21/2012 A breakthrough today in the ongoing issue concerning claims that are being processed as out of network when the provider is clearly in network. It was learned today on those providers that were transitioned over when New Directions took over. At minimal the LCSW’s were input with an incorrect taxonomy code. As a result when claims were submitted with a correct taxonomy these claims were rejected and instead the Group or pay to provider information was used in processing the claim.
It is believed that there are more providers affected by this problem. So for those of you who do your own billing you may want to contact New Directions Provider Enrollment to find out what taxonomy shows on your providers. If you have any comments or wish to discuss this further I invite you to make a comment below and I will be happy to share what my research.